Wednesday, January 25, 2012

Femoral versus Jugular: part three

Previousposts have discussed various iterations of the cathedia study, a study comparing femoral and jugular placement of dialysis catheters in patients in the ICU. As mentioned before, the femoral route was not associated with a higher rate of infection than the jugular route, except in patients with a BMI>28.5, and catheter dysfunction rates were lower in the femoral and R jugular sites compared to the L jugular.

The same group has published another follow-up paper, this time in CJASN, analyzing patients who crossed over from a jugular to a femoral line or vice versa. 134 patients were included in total and again, using the patients as their own controls, there was no increased incidence of infections and no change in catheter dysfunction in the femoral group compared to the jugular. One major limitation of this study was that they did not use ultrasound to insert the lines which must be standard practice in most institutions these days. It should also be said that all three of these papers are from the same database, which adds a significant bias, and it has not yet been replicated. Still, for a fellow planning on inserting a line late at night and wondering what the best practice is, it provides further evidence that the femoral route is safe in most cases and that at least you are not doing any harm by utilizing this route for access.

Certification

Disclaimer & Privacy

All opinions expressed on the website are those of the respective authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation. The appearance of external hyperlinks to other websites does not constitute endorsement. We do not verify, endorse or take responsibility for the accuracy, currency, completeness or quality of the content contained in these sites. There is no real life patient data on this website. The Renal Fellow Network does not profit from any of the material on this website. No advertisements are accepted. The Renal Fellow Network is not funded by any agency or company. Any information collected by our website, such as email addresses, will never be passed on to any third party, unless required by law. The Renal Fellow Network is moderated occasionally and posteriorly. Moderators are volunteers. Internet users posting comments on this blog should not be considered as health professionals.Comments posted on this Blog should be designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.We remind you that everyone can read and use your comments. You do not have the possibility to erase your own comments.Internet users commenting on the Renal Fellow Network must behave with respect and honesty at all times. Do not post any commercial/advertising comment. Posts will be deleted if commercial or advertising comments are made. Internet users commenting of the Renal Fellow Network must post information which are true and correct to their knowledge. Sources to health/medical claims must be provided when relevant. Moderators reserve the right to erase, without notification, any comment they would judge inappropriate.